Seen in the ED: Elevated LFTs and Anemia in a Young Female Student

History of present illness

A middle school student is brought to the hospital for 2 weeks of cough and persistent and worsening fevers, up to 103.3°F, over the past 3 days. She has a mild headache but reports no neck stiffness, photophobia, or vomiting. She has a mild and improving sore throat as well as a mild cough but no shortness of breath. Her parents say she has lost her color, but deny any melena, vomiting, rectal bleeding, or heavy menses.

Vital signs & physical examination

Vital signs are normal except for a pulse of 113 beats/min. Physical exam is normal except for tachycardia and mild skin pallor. Lungs are clear and the throat looks normal.

Initial diagnostic testing

• UA, CXR and BMP are normal
• AST and ALT are both elevated at 152 and 162 respectively
• CRP and ESR are normal
• CBC is normal except for a hemoglobin value of 5.2 with an MCV of 112 fl. WBC count is also 6.2 x 109/L with 72% lymphocytes